Archive for the ‘Fallon Health Insurance’ Category

You could be one of the millions of Americans getting a refund from your health insurance company soon. The Affordable Care Act has a law called the 80/20 rule, where insurance companies have to spend at least 80% of total premium costs on medical care or improving the quality of health care for consumers. In The Boston Globe’s “Health Insurance Companies Refund $15B to Mass. Consumers,” Chelsea Rice talks about the refunds going out and the companies who will be paying them. The U.S. Department of Health & Human Services released this data showing that Massachusetts consumers will be getting the second highest amount of refunds in the United States. The total refund amount for the U.S. is $332 million, which will pay around $80 a family those those receiving refunds. Florida health insurance companies will be paying the most refunds with $41.5 million owed. Massachusetts residents will be paid out $15 million, which amounts to $133 per family getting a refund.

Almost all of Massachusetts’ residents have health insurance, most through their employer, but 1/4 of them still struggle with the burden of high health insurance costs. The ACA’s 80/20 rule brings transparency and competition to the health insurance marketplace. It also offers greater value to consumers in their health insurance plans. Large group plans have to follow an 80/15 rule. Insurance companies operate more efficiently when they are following this rule by cutting out unnecessary expenses. They have been able to lower premiums throughout the U.S. by $3.8 billion. Companies who do not follow the 80/20 rule during their fiscal year have to refund the excess they spent to consumers in their health insurance plan. Those receiving refunds will get them by August 1 either by check, a discount in next years premium, an account reimbursement or a direct reimbursement through their company.

In Massachusetts, more than 208,000 consumers will be receiving an average refund of $133 per family. This new 80/20 rule has made quite a shift in the amount of upfront value that consumers receive from their health insurance plans. The biggest shift by far has been in the individual health insurance market. Back in 2011, the HHS found that 61% of consumers in the individual market received upfront value from their plans. Just two years later, 81% of people are receiving upfront value from their individual health insurance plans. Ten health insurance companies in Massachusetts will be sending out refunds, including Fallon Community Health Plan, Neighborhood Health Plan Inc. and Tufts Associated HMO. If you are one of the Americans receiving a refund from your health insurance company, look for that in the next week.

Starting in 2014, Americans will be using health exchanges to shop for their health insurance. The exchanges were put into place by the Affordable Care Act of 2010 and are supposed to be one-stop shops for Americans to get affordable insurance coverage from companies like Fallon Health Insurance. The goal is for the exchanges to allow individuals and small businesses looking for health insurance to join forces and be able to purchase health insurance coverage together. With larger purchasing power, they should be able to get affordable care at the kind of discounted prices that large businesses can. Tax subsidies and cost-sharing discounts will also be given to individuals below a minimum income level to help with financial assistance.

According to Insurance Journal’s “Midwest States Getting $1M Each for Health Exchanges,” $49 million will be given out by the U.S. Department of Health and Human Services to help establish the health exchanges in individual states. Illinois, Nebraska, North Dakota, and South Dakota will each receive $1 million to get their health insurance exchanges up and running. All states were given the option to run their own insurance exchanges with companies like UPMC. States that choose not to run their own exchanges will have one created and run by the federal government. Those states receiving a portion of the $49 million will use that money to start their exchanges and determine how they will actually operate.

As of today, college students and their parents have a lot to look forward to regarding the health insurance changes going into effect. Health Insurance Sort published a news article regarding the changes entitled “What health care reform means for students.” Students will compare health insurance costs since they can now stay on their parents’ insurance plans until the age of 26. Many students have gone without health insurance after being kicked off of their parents’ plans at age 23. This new health care reform is part of President Obama’s Health Care Reform Bill of 2010.

Health Insurance Sort’s article clears up misconceptions with the law and explains to college students and their parents how they will be affected now that this provision has taken effect. Some insurance companies opted to follow the new law as soon as it was passed rather than waiting until today’s deadline. As of today, everyone from Fallon Health Insurance to Mercy Health Plans will be covering college students longer. You will learn about how students’ privacy will be protected, what happens when a student goes to college out of the service area, if employer-sponsored plans will see an increase in premium cost, who may not be eligible, and when purchasing a basic plan from the college may be more beneficial from this article.

Even if seniors weren’t planning to change their Medicare drug plans this fall, they may be forced to because the number of available plans is decreasing. This could effect three million seniors, according to the Associated Press article “More than 3M seniors may have to switch drug plans.” Ricardo Alonso-Zaldivar’s article says that the government’s goal by reducing the number of plan offerings is to simplify and streamline Medicare. Seniors with drug plans through Medicare and a private insurer like Fallon Health Plans might have to pick a new drug plan if theirs is discontinued. It is possible that their insurance company will automatically reassign them to a new plan though, saving the headache of switching and possibly saving them money.

While most states currently offer around forty different choices for Medicare drug plans, this change will lower that number to around thirty per state. The government hopes that this will decrease the confusion felt by some Medicare recipients. It is possible that when seniors compare health insurance changes they could see differences in their premiums or copayments. The changes could be better or worse. While some current Medicare recipients may have a small disruption, these changes should make it much easier for new recipients to join Medicare in the future. Many Republicans are arguing that this is just what President Obama said he wouldn’t do, reduce the number of choices that citizens have regarding their health insurance. But consumer advocates say that these changes have been needed for years and will only benefit the population by reducing confusion.

In the past month approximately 2,400 Americans have signed up for President Obama’s high risk health insurance pools. This information comes from Gene Rickman’s “2,400 Apply for High Risk Health Insurance Pool,” in Top News. The exact state by state data is not yet available, but this number includes members in both states that are running their own high risk pools and states like South Carolina that are letting the government run the high risk pools for them. Beginning in 2014, health insurance companies like UPMC will not be able to deny insurance coverage because of any preexisting conditions. To bridge the gap between now and then, the U.S. federal government has required these high risk health insurance pools.

The Affordable Care Act passed earlier this year calls for the mandatory stop to preexisting condition denials by health insurers in less than four years. Preexisting conditions can include cancer, asthma, diabetes, HIV or AIDS, and even pregnancy. It is currently almost impossible to get health insurance coverage from companies like Fallon Health Insurance if you have one of these or another preexisting condition. Within the last month, Americans have been able to sign up for individual state high risk health insurance pools where they will be able to obtain some type of health insurance coverage. The federal government offers the states subsidies for this program, but states do have to utilize their own government funds as well.

Massachusetts state regulators are trying to get skyrocketing health care costs under control. According to The Boston Globe article “State caps more health insurance rates” by Robert Weisman, 137 health insurance companies had their rates capped at 2009 levels. Fallon Health Plans and two others filed appeals on the decision; they will wait until later in the summer to find out what will come of their appeals.

Four companies in the small group market did have premium increases in the single-digits approved. Three insurers will be providing more information to the state before a decision is made on their requested double-digit increases. This latest decision is for the three-month period ending in September and is quite a different outcome than the last three-month period where nearly all of the premium increases were rejected.

While officials with the state argue that they are using these rate caps to help small businesses and working families struggling in a tough economy, insurance companies say that the rates officials are forcing upon them are wreaking financial havoc by making them operate at a loss. Insurers were given the ability to prove their case for increasing customers’ rates. If they can’t prove necessity, their rate increases will not be approved.

From the Associated Press’ Marilynn Marchione, “Treating HIV also prevents its spread, study finds.” A recent Canadian study, partly funded by the United States, found that the rate of AIDS infections decreased in the areas of Canada where more people started taking drugs for the disease. Infections dropped by 3% in British Columbia, where the study was performed. Since 1996, the number of new infections has been reduced by half, which correlates with a rise in treatment since Canada has offered free AIDS care and the introduction of modern AIDS drug treatments. The director of the U.S. National Institute of Allergy and Infectious Diseases states that where there is more drug therapy there is less transmission. He says that there is really no other explanation for the drop in news AIDS cases in Canada.

While the U.S. does not offer free treatment to everyone, Fallon Health Insurance and other health insurers often cover the cost of drug therapy for AIDS patients. With 1.1 million HIV infected Americans, AIDS experts hope that the results of this study will help improve U.S. funding for AIDS patients to get drugs. While there are 55,000 new cases of AIDS each year in the U.S., that is a number that hasn’t increased or decreased in a decade or so. Since AIDS is incurable, it is crucial to find a way to stop the spread of the disease. Previous studies in Africa showed similar results, as did studies indicating that pregnant women taking AIDS drugs are less likely to pass the disease on to the unborn fetus. An increased effort in Washington, San Francisco, and New York to test and give early treatment to more people will hopefully be taken throughout the U.S. soon.

The laparoscopic sleeve gastrectomy is a new weight loss procedure available to treat obesity and diabetes. According to “Insurers Divided Over Experimental Stomach Surgery to Treat Obesity,” Matthew Sturdevant of The Hartford Courant says that some insurers are not covering the procedure while others are. The procedure has the same goal as gastric bypass and gastric banding. It shrinks the stomach to 15% of the original size so that you eat less. Fallon health insurance and other insurers have had to make a tough decision whether or not to cover the newer procedure. Some companies believe that more research should be done, while others are already covering the costs to help avoid the other long term costs related to obesity and diabetes.

UnitedHealthCare and Aetna decided to cover the sleeve gastrectomy at a cost of $16,000-$25,000 for the procedure. CIGNA Corp. and Anthem Blue Cross Blue Shield of Connecticut are not covering the procedure currently because they believe it is experimental and needs more research to be proven effective and safe. The sleeve gastrectomy procedure turns the shape of the stomach into a sleeve rather than the natural kidney bean shape. It is deemed better than gastric bypass by some people because it doesn’t skip over the small intestine where important nutrients are absorbed. The benefit over gastric banding is that you don’t have to have repeat surgeries like you do to adjust the gastric band. Some advocates believe that the sleeve gastrectomy pays for itself in about two years because of the obesity related health costs that are avoided.

With half a million premature babies born each year in the United States, it’s amazing that the cause of many of these early births is still a mystery in the medical world. In “Premature births still a medical mystery” by Rachael Rettner of Live Science, Rettner discusses recent developments about the combination of factors leading to premature labor and delivery. A traditional pregnancy lasts between 38 and 42 weeks, or approximately 9 months. Any birth at 37 weeks or before is considered a premature baby, often resulting in underdeveloped systems and medical issues.

Around half of premature deliveries can be easily explained. When a mother is carrying multiple children at once, there is a much greater chance that she will not carry the babies full term. Many labors are also induced or c-sections performed because of complications with the pregnancy. In those early labors that don’t fall into either of these categories though, science is working to determine what is causing them. The three things that they believe are important to further research are genetics, infections, and a woman’s social and lifestyle environment.

Pathogenic infections are believed to cause preterm births because they make a pregnant woman’s immune system work in overdrive, which can trigger labor. Scientists think that infections may actually cause up to a quarter of premature births. It’s also believed that a woman’s genetics may play a significant role in determining whether they will have a premature labor and delivery. Premature births run in some families and women are more likely to have subsequent premature births if they already have had one. Environmental factors also play a role in premature birth rates. Areas with high poverty levels tend to have more women delivering prematurely based on healthcare availability, housing, their jobs, and social norms. Income, stress levels, and eating and drinking habits may also play a role.

As scientists learn more about normal pregnancies and labor, they will better be able to translate that knowledge to premature labor and birth cases. The main goal is avoiding premature births to help babies and children be healthier and reduce insurance costs for Fallon Health Plans and other health insurance companies.

The Patient Protection and Affordable Care Act contains a provision that may force smaller insurance companies like Fallon Health Insurance out of the individual insurance market completely. According to “Actuary: Act Fast, Or Individual Health Insurers Will Flee,” Allison Bell of Life and Health National Underwriter summarizes the dilemma. The minimum medical loss ratio requires health providers to spend 80% or more of their premium revenue on paying the medical claims of their insureds. Experts recommend regulators come up with a way for companies to make this transition. They worry that smaller companies will opt out of providing individual health insurance because of this new provision. If that is the case, they would most likely have to let insureds know by June to give them a 6 month warning that they won’t offer individual coverage next year.

Those hoping for some transitions to be spelled out would like to see them immediately so companies know before making the decision to leave the individual market. The idea behind the 80% medical loss ratio is that insurance companies like UPMC would just reduce administrative costs and other costs they have not related to claims. It might be hard for insurers to reduce those costs so quickly, not to mention the fact that it will likely hurt smaller insurers much more. In order to stay competitive, smaller insurance companies offer lower rates for the same coverage as larger companies and have higher marketing and administrative costs. One suggested solution is to make the minimum medical loss ratio smaller for insurance companies with less market share or for those who sell low-cost plans like high deductible insurance. Without any changes it is very possible that more smaller insurers will stop selling individual health plans.